乳腺癌患者的年齡因素不足以單獨(dú)決定她是否應(yīng)該接受包括乳房腫瘤切除術(shù)和放射線治療的標(biāo)準(zhǔn)乳房保留治療。但是,，根據(jù)一項(xiàng)發(fā)表在4月1日的愛思唯爾期刊《國際放射線,、腫瘤學(xué),、生物學(xué)、物理學(xué)雜志》（該雜志為美國放射治療學(xué)和腫瘤學(xué)學(xué)會(huì)的官方期刊）上的研究,，一旦存在其它健康問題,，則應(yīng)該根據(jù)個(gè)體患者的年齡和共并癥的類型來選擇治療手段。
婦女患乳腺癌的風(fēng)險(xiǎn)隨著年齡的增長而增加,。根據(jù)國際癌癥協(xié)會(huì)的統(tǒng)計(jì)預(yù)測,，年齡在75歲到79歲之間的婦女有著最高的乳腺癌診斷率，每10萬個(gè)人中有497個(gè)病例,。在這一年齡段的婦女除了癌癥以外大都還有著其他的健康問題,。根據(jù)《臨床流行病學(xué)雜志》的1999年婦女健康年齡研究，大多數(shù)年長的乳腺癌患者有至少一種其他疾病,，超過一半的年齡大于65歲的患者有至少3種其他健康問題,。
這項(xiàng)研究由賓夕法尼亞大學(xué)醫(yī)學(xué)院的放射線腫瘤學(xué)系、生物統(tǒng)計(jì)和流行病學(xué)系,、醫(yī)學(xué)系和老人病學(xué)部合作進(jìn)行,，目的是確定相對于沒有共并癥的患者,，這些其他健康問題對接受標(biāo)準(zhǔn)治療的乳腺癌患者的影響，并確定年齡是否可以成為否決一些標(biāo)準(zhǔn)治療手段的因素,。
大多數(shù)用來比較放射線使用與否的乳房保留手術(shù)效果的隨機(jī)試驗(yàn)結(jié)果都表明,，使用放射線更有利。但是試驗(yàn)中的大多數(shù)手術(shù)都把70歲以上的患者排除在外,，因此關(guān)于放射線對老年婦女的影響并沒有很多數(shù)據(jù),。
在1979年和2002年之間，238名70歲以上,、患有一期或二期浸潤型乳腺癌的患者,，接受了乳房保留治療，她們的結(jié)果分年齡段和共病癥進(jìn)行了比較,。大多數(shù)被研究的患者患有輕度的共病癥,。
研究人員發(fā)現(xiàn)，被研究對象死于乳腺癌的比率與各個(gè)年齡段沒有共并癥的患者相近,。她們還發(fā)現(xiàn),，大多數(shù)患有早期乳腺癌和輕度共并癥的老年婦女事實(shí)上更適合于放射線治療，并有最小的副作用,。
全部病人的術(shù)后5年和術(shù)后10年的存活率分別為80%和50%,。但是，在術(shù)后10年的病人更多地死于并發(fā)癥而不是乳腺癌,。
美國Moffitt癌癥中心放射線腫瘤主任Eleanor Harris說：“醫(yī)生們需要知道是共病癥而不是年齡,，應(yīng)該成為決定老年病人治療方案的決定因素。在這個(gè)領(lǐng)域有種說法認(rèn)為年長的婦女比年輕的婦女需要較少的治療,，但是我們不應(yīng)該僅僅因?yàn)樗齻兡挲g大于70歲而給予不充分的治療,。”（科學(xué)網(wǎng) 劉樂/編譯）
生物谷推薦原始出處：
（International Journal of Radiation, Oncology, Biology, Physics），doi:10.1016/j.ijrobp.2007.08.059,，Eleanor E.R. Harris, Lawrence J. Solin
The Impact of Comorbidities on Outcomes for Elderly Women Treated With Breast-Conservation Treatment for Early-Stage Breast Cancer
Eleanor E.R. Harris M.D.*, , , Wei-Ting Hwang Ph.D.†, Sandra L. Urtishak M.D.*, John Plastaras M.D., Ph.D.*, Bruce Kinosian M.D.‡ and Lawrence J. Solin M.D.*
†Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
‡Department of Medicine, Division of Geriatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
*Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA
Purpose
Breast cancer incidence increases with age and is a major cause of morbidity and mortality in elderly women, but is not well studied in this population. Comorbidities often impact on the management of breast cancer in elderly women.
Methods and Materials
From 1979 to 2002, a total of 238 women aged 70 years and older with Stage I or II invasive carcinoma of the breast underwent breast-conservation therapy. Outcomes were compared by age groups and comorbidities. Median age at presentation was 74 years (range, 70–89 years). Age distribution was 122 women (51%) aged 70–74 years, 71 women (30%) aged 75–79 years, and 45 women (19%) aged 80 years or older. Median follow-up was 6.2 years.
Results
On outcomes analysis by age groups, 10-year cause-specific survival rates for women aged 70–74, 75–79, and 80 years or older were 74%, 81%, and 82%, respectively (p = 0.87). Intercurrent deaths at 10 years were significantly higher in older patients: 20% in those aged 70–74 years, 36% in those aged 75–79 years, and 53% in those 80 years and older (p = 0.0005). Comorbidities were not significantly more common in the older age groups and did not correlate with cause-specific survival adjusted for age. Higher comorbidity scores were associated with intercurrent death.
Conclusions
Older age itself is not a contraindication to standard breast-conservation therapy, including irradiation. Women of any age with low to moderate comorbidity indices should be offered standard breast-conservation treatment if otherwise clinically eligible.
